Provider Demographics
NPI:1174628572
Name:AZHAR ASLAM MD LLC
Entity Type:Organization
Organization Name:AZHAR ASLAM MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AZHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ASLAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-422-9036
Mailing Address - Street 1:1770 E LAKE SHORE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-3832
Mailing Address - Country:US
Mailing Address - Phone:217-422-9036
Mailing Address - Fax:217-422-9812
Practice Address - Street 1:1770 E LAKE SHORE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-3832
Practice Address - Country:US
Practice Address - Phone:217-422-9036
Practice Address - Fax:217-422-9812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-108233207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006113660001Medicaid
NY0006113660001Medicaid
PAAS867969OtherBCBS
B36300Medicare UPIN
PA0006113660001Medicaid